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PEDIATRICS Vol. 108 No. 1 July 2001, pp. 1-7
Received Sep 6, 2000; accepted Nov 9, 2000.
, §,
,
From the * Department of Ambulatory Care and Prevention, Harvard
Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts;
Objective. To test whether an
educational outreach intervention for families and physicians, based on
the Centers for Disease Control and Prevention (CDC) principles of
judicious antibiotic use, decreases antimicrobial drug prescribing for
children younger than 6 years old.
Setting. Twelve practices affiliated with 2 managed care
organizations (MCOs) in eastern Massachusetts and northwest Washington
State.
Patients. All enrolled children younger than 6 years old.
Methods. Practices stratified by MCO and size were
randomized to intervention or control groups. The intervention included
2 meetings of the practice with a physician peer leader, using
CDC-endorsed summaries of judicious prescribing recommendations;
feedback on previous prescribing rates were also provided. Parents were
mailed a CDC brochure on antibiotic use, and supporting materials were displayed in waiting rooms. Automated enrollment, ambulatory visit, and
pharmacy claims were used to determine rates of antibiotic courses
dispensed (antibiotics/person-year) during baseline (1996-1997) and
intervention (1997-1998) years. The primary analysis (for children 3 to <36 months and 36 to <72 months) assessed the impact of the
intervention among children during the intervention year, controlling
for covariates including patient age and baseline prescription rate.
Confirmatory analyses at the practice level were also performed.
Results. The practices cared for 14 468 and 13 460
children in the 2 study years, respectively; 8815 children contributed
data in both years. Sixty-two percent of antibiotic courses were
dispensed for otitis media, 6.5% for pharyngitis, 6.3% for sinusitis,
and 9.2% for colds and bronchitis. Antibiotic dispensing for children 3 to <36 months old decreased 0.41 antibiotics per person-year (18.6%) in intervention compared with 0.33 (11.5%) in control practices. Among children 36 to <72 months old, the rate decreased by
0.21 antibiotics per person-year (15%) in intervention and 0.17 (9.8%) in control practices. Multivariate analysis showed an adjusted
intervention effect of 16% in the younger and 12% in the older age
groups. The direction and approximate magnitude of effect were
confirmed in practice-level analyses.
Conclusions. A limited simultaneous educational outreach
intervention for parents and providers reduced antibiotic use among
children in primary care practices, even in the setting of substantial
secular trends toward decreased prescribing. Future efforts to promote judicious prescribing should continue to build on growing public awareness of antibiotic overuse.
University of Washington, Seattle, Washington; § Group Health
Cooperative, Seattle, Washington; Centers for Disease Control and
Prevention, Childhood and Respiratory Diseases Branch, Atlanta,
Georgia; ¶ Veterans Administration Medical Center, Philadelphia,
Pennsylvania; # Tufts University, Medford, Massachusetts; ** Vasca, Inc,
Tewksbury, Massachusetts; and Channing Laboratory, Boston,
Massachusetts.
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